Tag Archive for: gratitude
“What is it you plan to do with your wild and precious life?”
What if this famous line by poet Mary Oliver was not only relevant to people in their teens, but also in midlife? Given the considerable research on longevity, people are living healthier and longer lives, redefining what it is to be middle-aged. There is an antiquated cultural belief that once a person reaches the age of about 50, it’s too late to reinvent themselves or choose a new path. But now that we are living longer, we have a more expansive sense of time left to experience more joy, meaning, and impact.
“Rather than a midlife crisis, I call this time in our lives a midlife reckoning,” says Barbara Waxman, MS, gerontologist, leadership coach, and Stanford Lifestyle Medicine advisory board member. “Many people come to me worried that it’s too late to re-write their script and to recalibrate their on-going commitment to purpose. The truth is there is no ‘sell by’ date limiting your usefulness when you have decades of life and leadership in front of you.”
Similar to adolescence, Waxman coined the term middlescence as the period between early midlife and later midlife when many transitions occur, such as physical changes, menopause, andropause, empty nest, divorce, and caretaking of parents. With her clients, Waxman promotes the idea that middlescence is not the beginning of the end; rather, it can be a time to re-evaluate how one spends their time, explore different hobbies and careers, and declare a new purpose based on their current values, perspectives, and circumstances.
“Midlife is a perfect time to revisit and reassess choices we’ve made earlier in life that no longer fit,” says Waxman. “We have a better understanding of ourselves and what we care about. We’ve honed our skills, have more confidence, and have more to offer. We might have an inner calling that is shifting us in a different direction.”
What if I Can’t Find My Purpose?
Not everyone has a clear sense of purpose. In fact, many people struggle with “finding” their purpose and feel ashamed for this lack of clarity. But rather than define our purpose based on what is reasonable or practical, Waxman invites us to listen within and ask ourselves what is really important to us.
“Defining your purpose doesn’t come from the brain alone; it also comes from the heart and the gut. So instead of trying to ‘figure it out’, ask yourself, ‘What feels right?’” says Waxman. “When people have a clear sense of purpose, it’s like the wind beneath their wings—there’s an effervescence in how they show up.”
Waxman also says that many people put so much pressure on themselves to have a grandiose purpose, such as saving the environment or ending world hunger, that they don’t acknowledge the importance of the smaller contributions they make every day.
When working with clients, Waxman often references this quote from Mother Theresa: “Not all of us can do great things, but we can do small things with great love.”
“The obsession with finding one’s purpose can cause the stress that blocks you from seeing what is right in front of you and what you’re already doing,” says Waxman. “The little things you do each day, such as calling your loved ones or cooking meals for your family, count. I call these your ‘little p’ purposes, which are just as important as your ‘big P’ purpose. And the little p’s add up to create a purposeful life.”
Three Steps to Find Your Purpose in Midlife
When trying to identify our purpose, Waxman recommends that we start small and notice the little things in our lives that bring us joy. Waxman helps us break down the process of finding our “big P” purpose by offering these three journal prompts:
- What sparked joy today?
- What is a skill we have related to this joy?
- What need in the world does this skill fulfill?
Steps 1 and 2 can be defined as our “little p” purposes, leading to step 3—a potential “big P” purpose. For example, in Waxman’s life, working in her vegetable garden sparks joy and she has a skill of cooking (“little p” purposes). She applies this skill while volunteering at a soup kitchen every week, which reduces food waste and feeds the hungry in her community (“big P” purposes).
“Since what brings us joy and our skills change over time, it makes sense that we would have multiple purposes in our lifetimes,” says Waxman. “Living a purposeful life can be as simple as having a sense of gratefulness and being the best you can be every day. These small things are big things—it’s just about recognizing them to be so.”
By Angel Cleare, BS
As we prepare our holiday meals, we may reflect on how this family gathering unfolded last year. It may have started well, with many smiles and joyful conversations of family members sharing what was happening in their lives. But, when everyone sat down at the dinner table, one family member couldn’t stop complaining about the food, and another couldn’t resist voicing their antagonizing opinions. Knowing this may happen again, we may ask ourselves, “What can we do differently this year?”
“As we all know, we can’t control what others say or do, but we have some control over how we react, and this is where mindfulness can help,” says Sharon Brock, MS, member of the Stanford Lifestyle Medicine Gratitude & Purpose pillar and UCLA Certified Mindfulness Facilitator. “By centering yourself with meditation before guests arrive, you can set the tone for harmony. And if conflict still arises, you can practice mindfulness in the moment to help you handle the situation with more composure.”
Brock is the bestselling author of The LOVEE Method, a five-step mindfulness tool to help manage emotions in real-time and bring us into a state of clarity and balance. LOVEE is an acronym that stands for label, observe, value, embrace, and equanimity.
“Let’s say you experience a strong emotion, like anger or anxiety. It can be processed by the mindfulness practices of labeling, observing, valuing, and embracing the emotion. When the emotion has settled, a clearing is created for equanimity to arise,” says Brock.
“Equanimity means having an even-keeled, calm, and balanced mind, which can come in handy when spending the day with challenging in-laws,” says Brock.
How to Respond vs. React
So, what can we do when a disagreeable family member starts talking politics and activates a surge of anger within us? Most people either retaliate with a scathing comment or hold back and swallow their rage. Since neither option is a healthy way to process emotions, Brock offers a third option to transform this difficult emotion with the steps of LOVEE.
“If anger gets activated while seated at the dinner table, rather than be overly expressive or repressive, we can take a deep breath and mentally do the label and observe practices,” says Brock.
When doing the label practice, Brock recommends phrasing the label “anger is rising” rather than “I am angry” so that we create some space between ourselves and the emotion. For the observe practice, Brock advises doing a quick body scan to locate and observe the emotion as a sensation in the body. She shares that observing our emotions allows us to recognize that they are temporary experiences, not permanent states. Knowing that the emotion will eventually pass can help us stay calm in the moment.
“Emotions are energies in motion; they are not personal,” says Brock. “When we don’t identify with our emotions and we simply observe them as fluid sensations in the body, we are acknowledging the emotions for what they actually are—energies in the body that rise and fall, come and go.”
Brock offers these scripts to say to ourselves in the heat of the moment to soothe our emotions:
- “Anger is rising. I feel the sensation of my heart beating fast. I take a deep breath, observe the sensation, and not react. I may respond after the emotion has passed.”
- “Anxiety is rising. I feel the sensation of clenching in my stomach. I take a deep breath, observe the sensation, and not react. I may respond after the emotion has passed.”
- “Sadness is here. I feel the sensation of heaviness in my chest. I take a deep breath, observe the sensation, and not react. I may respond after the emotion has passed.”
Mindfulness and Self-Compassion
Brock says that the label and observe practices are effective mindfulness techniques for calming ourselves during a time of conflict. However, if the anger remains after the challenging moment has passed, she recommends going through the rest of the steps of the LOVEE Method as a formal meditation.
After label and observe, the value and embrace practices bring self-compassion into the meditation, which research shows offers psychological healing. During the value practice, we accept our emotions as natural aspects of the human condition, acknowledging that others would feel the same in the given situation. We also value our emotions because they have something to tell us, such as revealing a desire for harmony within the family.
Self-compassion deepens with the embrace practice. Here, we give our emotion a “hug” and say to ourselves, “I see you. I hear you. What do you need?” When working with anger, the need is often for respect. In this case, Brock recommends putting both hands on the heart and saying to ourselves, “I respect you.”
“Acknowledging that we are not alone and offering ourselves what we need helps soothe our emotions. With these practices, we are offering ourselves compassion and we are learning to take care of ourselves emotionally,” says Brock. “Over time, self-compassion practices help us to meet our own emotional needs, which fosters independence, resilience, and self-confidence.”
Cultivating Equanimity
After we have processed the emotion with the practices of label, observe, value, and embrace, the final step is equanimity. Here, we return our attention to the original person or circumstance that activated the intense emotion.
During this step, Brock invites us to repeat the equanimity phrase: “Things are as they are, may I accept things just as they are.” Or, in the case of the difficult family member: “They are who they are, may I accept them just as they are.”
Brock clarifies that accepting is not the same as condoning someone’s behavior or implying that the circumstance is morally right; rather the purpose of repeating these phrases is to bring our nervous system into balance and cultivate equanimity in our psyche.
“Equanimity is not about stepping back and not taking action; rather it allows us to take wise action from a place of calm and reasoning,” says Brock. “With an equanimous state of mind, we release resistance and resentment, and we are better able to navigate challenging circumstances with strength and grace.”
Click here to listen to the LOVEE Method meditation or here to learn more about Brock’s mindfulness offerings.
More and more people today identify as spiritual but not religious. In this blog, we explore and appreciate what spirituality is as human beings to increase our capacity for more spiritual experiences in our lives.
“Spirituality is an individual experience,” says Bruce Feldstein, MD, BCC, Head of Stanford Lifestyle Medicine’s Gratitude & Purpose pillar. “As a chaplain and professor providing and teaching spiritual care for the past 25 years, I’ve often encountered people who identify as spiritual but not religious. I’m always amazed by the wide variety of ways people experience and express their spirituality.”
What Do We Mean by Spirituality?
Dr. Feldstein draws from these descriptions of spirituality with his patients and students:
- “Spirituality is the way you find meaning, hope, comfort and inner peace in your life. Many people find spirituality through religion. Some find it through music, art, or a connection with nature. Others find it in their values and principles.” – American Academy of Family Physicians
- “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” – Journal of Palliative Medicine
- Spirituality is a core dimension of our humanity. “We are not human beings having a spiritual experience. We are spiritual beings having a human experience.” – Pierre Teilhard de Chardin
Discover What Spirituality Means for You
As a professor, Dr. Feldstein previously taught a course for Stanford medical students entitled “Spirituality and Meaning in Medicine.” With the intention of allowing students to discover and appreciate spirituality in their lives (both personally and professionally as medical students), he led them through this exercise:
First, he shared the descriptions of spirituality listed above and then invited them to explore what spirituality means for them from their personal experience.
Then, he said to the class: “Recall a time in your life you would call spiritual or deeply meaningful, whatever that means for you.” After this reflection, Dr. Feldstein gave the students these journal prompts:
- What was the situation? Were you alone or with others?
- What thoughts or emotions occurred during this time?
- What about this memory caused you to recognize it as spiritual or deeply meaningful?
“Every student had a story, and every story was unique,” says Dr. Feldstein. “Some were moments of awe or deep peace; others were stories of the kindness of strangers where they didn’t feel alone; others were ‘a-ha’ moments of guidance and realization. These spiritual experiences were all moments of spontaneous happening–it wasn’t on the calendar. Often, they took place outside of their everyday routines.”
Dr. Feldstein observed that this reflection exercise increased all the student’s capacity to recognize and cultivate spirituality in their lives.
“We all have this capacity for spiritual experiences, but many of us don’t recognize it,” says Dr. Feldstein. “Most of us are living in black and white, but recognition of these experiences can move us into technicolor.”
Activities that Can Allow for Spiritual Experience
Although we can’t control, predict, or anticipate these spiritual experiences, we can put ourselves in situations and states of mind that make them more likely.
In his class, Dr. Feldstein asked his students to share the situations or activities where they had spiritual or deeply meaningful experiences.
Here are some examples of what the students shared:
- Life-cycle moments, including births, deaths, weddings, or graduation days.
- While listening to music that brought a deep feeling of peace.
- While volunteering for a cause that was meaningful to them.
- While taking a walk in nature and pausing to admire the beauty of the trees.
- While offering or receiving kindness and compassion while in conversation.
- While connecting with others in book groups or reading meaningful books on their own.
- While singing, dancing, and/or praying.
- While visiting a loved one at the hospital.
- While cooking with friends and mindfully eating the food.
- While taking a yoga class and connecting to their breath.
- During a morning meditation when focusing on gratitude.
In pursuit of well-being, Dr. Feldstein invites us to choose a few daily activities that are spiritual and meaningful for us. This will help us to be more attuned to spiritual experiences when they spontaneously occur. And when they do, he invites us to pause and acknowledge them, savor them, and feel gratitude afterward.
“As human beings, we have the capacity for spiritual experiences because we are spiritual by nature,” says Dr. Feldstein. “Being spiritual is not something we need to ‘do’, it’s what we already are, so we just need to allow for it.”
By Donovan Giang
This blog is part of our Gratitude & Reflection newsletter. If you like this content, sign up to receive our monthly newsletter!
With the holiday season upon us, the spirit of joy is in the air. From magazine advertisements of happy families having a delicious meal to hearing Christmas carols in department stores, we are constantly being fed the message that we should be joyful at this time of year. However, if we are not feeling joy, these messages can be a continual reminder of what we are missing, often making us feel worse.
Luckily, researchers such as Akivah Northern, DSci (c), MDiv member of the Stanford Lifestyle Medicine Gratitude and Reflection pillar, explore different ways to experience and cultivate joy in our lives. Northern is a chaplain, doctoral candidate at Loma Linda University and she received her Masters of Divinity from Yale University. Her dissertation research is a Stanford IRB approved study, exploring medical students’ joys and challenges as they were expressed during Reflection Rounds, a required course for medical students taking their core clinical clerkships at Stanford School of Medicine. Northern co-facilities Reflection Rounds with Bruce Feldstein, MD, BBC who brought Reflection Rounds to Stanford seven years ago.
“We know that medical students are challenged, however less is spoken about their joys, which are equally as important,” says Northern. “Joy in medicine is an ancient aspiration that dates back to the fourth-century Hippocratic Oath, which is still taken by physicians today. Experiencing joy as a physician is part of the very foundation of medicine, so it is essential to cultivate it as medical students begin working with patients.”
So, how does one define joy? In Hebrew and Greek, joy has many meanings, such as delight, exaltation, rejoice, gladness, cheer, exuberance, and triumph. Northern shares that during challenging times, feelings of sorrow and grief are valid and a natural part of the human experience.
“There are times when life brings us situations when we have to lament, but we don’t have to stay there ,” she says. “There are so many different types of joy, such as received joy, divine joy, announcing joy, profit joy, fruit of the spirit joy, and jumping for joy, joy! So, even during hard times, we can choose to savor the myriad of joys and intentionally create reasons for joy.”
Joy Linked to Gratitude
In exploring joy, researchers examined the relationship between joy and gratitude. This study consisted of self-report measures from university students. To measure joy, the researchers used scales developed within the study, such as the State Joy Scale and the Dispositional Joy Scale. To quantify gratitude, the researchers used scales of Dispositional Gratitude, a Gratitude Questionnaire, and a Gratitude, Resentment, and Appreciation Test. These self-report measures found that joy can increase gratitude and gratitude can increase joy, suggesting an “intriguing upward spiral” between the two.
“Research linking positive emotions like joy and gratitude to well-being is vital for patients as well as for healthcare providers,” says Northern. “For example, preliminary results from my research showed that medical students’ expressed joy when they were grateful for teachers, peers, and for the profession of medicine, but especially for their patients”
Looking at her data, Northern found that in 30 expressions of joy by medical students, 17 were associated with gratitude. For example, one medical student expressed joy as gratitude for being “deeply honored” to have met and had “easy, comfortable conversations” with a patient, his spouse and family. Another student expressed joy as appreciation for the way his physician mentor engaged with a patient, describing the interaction as “beautiful and wonderful.” The student appreciated seeing the physician be present with the patient, admiring the quality of the physician’s presence and the “commonality” the physician and patient shared. A third medical student expressed that although she could not deliver medical care to a distraught patient with overwhelming life stressors, she still felt joy because “ultimately, just being a listening human was the number one therapy delivered that day.”
“A surprising finding from the research was when medical students’ expressed joys and challenges simultaneously, they often had a breakthrough to a discovery or new joys and insights,” says Northern. “When we allow joys and challenges together, we become more resilient and emotionally buoyant, and often something new emerges from the experience.”
Joy Linked to Well-being
In recent years, joy has become an object of study in the humanities and medicine. Joy, as a positive emotion, has consistently been suggested to be a key aspect of well-being in the field of positive psychology. Martin Seligman, the founder of this field, developed the PERMA+ Model. The “P” in PERMA+ stands for positive emotion (joy, gratitude, and optimism), the “E” for engagement, the “R” for relationships, the “M” for meaning, the “A” for accomplishments, and the “+” for other elements beyond these.
In further research on joy as a positive emotion, researchers conducted a study to examine the pre-existing strategies individuals use to maintain high levels of positive emotion. To measure the strategies the participants (university students) used, the researchers applied an Emotion Regulation Profile to categorize participant reactions to hypothetical situations. One result from this study found that mindfulness (being present in the moment) was positively correlated with positive affect.
Another way positive emotions (including joy) increase well-being at the physiological level is by increasing one’s resilience. In this study, university students prepared a short speech, which served the purpose of stimulating a stress response. Using cardiovascular measures (to gauge the stress response), ambient mood and emotion measures, and psychological resilience measures, the researchers found that positive emotions hastened cardiovascular recovery (a lower amount of time needed to return to baseline cardiovascular measures, including heart rate and finger pulse data) after the experimental stressor.
Another study examining the influence of positive emotions on physiological stress processes was the first to demonstrate that gratitude and thankfulness can buffer against the negative effects of acute stress on cardiovascular responses.
“Even in stressful times, joy can be a choice,” says Northern. “Even in a hard situation, we can look for joy. Even if we can’t see the joy currently, we can anticipate the joy that may come in the future from accepting the challenge, resolving it or reframing our understanding.. When we choose to approach challenges in the company of joy and hope, we are investing in our own well-being and our future.”
By Jonanne Talebloo
This blog is part of our Gratitude & Reflection newsletter. If you like this content, sign up to receive our monthly newsletter!
We have all heard the saying “mind over matter” when it comes to athletics and physical challenges. But can this saying be applied to health, healing, aging, and longevity? Studies suggest that optimism may play a leading role in improving not only one’s emotional well-being but also physical health and increasing lifespan.
Optimism, defined as the tendency to be hopeful and expect positive outcomes, has been linked to improved mental health and well-being in that it uplifts one’s mood and outlook on life. Optimism alone may not be the silver bullet for health and happiness, but studies show that it is one of many factors that can positively influence health, longevity, and lifespan.
For example, research shows that optimism helps diminish stress and anxiety, which lowers the stress hormone cortisol. Elevated levels of cortisol and blood pressure have been linked to an increased risk of stroke, hypertension and heart attack. Chronic stress can have negative effects on almost all of our bodily systems, including the endocrine system, where stress can impair communication between the immune system and the hypothalamic-pituitary-adrenal (HPA) axis, and potentially lead to immune disorders.
Optimism also assists with healing. Akivah Northern is part of the Stanford Lifestyle Medicine Gratitude and Reflection Pillar and earning her doctoral degree in Religion and Health at Loma Linda University. She is a chaplain, which are professionals who listen and accompany patients and their families in life-threatening, physical, existential, moral, or spiritual distress. Northern is the founder of a soon-to-open healthcare center that incorporates lifestyle medicine, chaplaincy intervention, and the arts.
“Optimism is not just helpful, it is vital for those who are suffering,” says Northern. “As a chaplain, I engaged patients in optimism and hope, instilled a sense of the sacred, and offered explorations regarding ultimate meanings. These conversations served as calming, hope-filled, and relieving medicine for patients.”
Optimism and Longevity
Recent studies have explored the connection between optimism and longevity and how a person with a positive outlook has the potential to live a longer, healthier life. A recent study revealed that optimism (defined as “the global expectation that things will turn out well in the future” and measured by cortisol stress reactivity and questionnaires) was linked to decreased cortisol levels, which is an important factor regarding increased longevity. Another study found that higher levels of optimism (assessed using the Revised Optimism-Pessimism Scale) were linked to increasing lifespan by as much as 15 percent.
In a review article examining a variety of health and longevity benefits associated with optimism, researchers found a whole host of benefits. Highlights from the review were that greater optimism predicted greater career success, better social relations, and better health. The article also concluded that the positive effects of optimism appeared to reflect individuals with a greater engagement in pursuit of desired goals. Another large-scale study showed that the link between optimism and increased longevity was independent of ethnic origin and applied across many racial and ethnic groups.
In order to understand how optimism can make such dramatic impacts on our health and longevity, the neural underpinnings of optimism have also been studied. Research suggests optimism activates areas of the brain involved in mood regulation, attention allocation, emotional expression, language processing, and perception of oneself. Modulating these areas with our thoughts may improve psychological well-being by improving one’s perception of the world, themselves, and self-expression.
“Optimism is the opposite of stress, worry and anxiety, which can increase inflammation and chronic illness in the body,” says Northern. “By leaning toward a calming and optimistic way of being, we are increasing not only our mental, emotional, and spiritual well-being, but also our physical health and longevity.”
Optimism can be Cultivated
Although optimism is defined as a trait ingrained in individuals, people can learn to develop optimism over time. Learned optimism can be cultivated through music, gatherings, and culture in community. This sense of community strengthened by optimism can promote individual well-being, contribute to advancements in public health, and even inspire social change on a global scale.
An example of cultivated optimism through culture and community is the fact that millions of Iranian women worldwide have learned to adopt an optimistic attitude in their fight for freedom and equality. Research also shows that optimism improves resilience, another essential characteristic for Iranian women. Optimism and resilience among the Iranian diaspora have been the foundation of a global community that continues to inspire change regarding women’s rights.
Optimism can also be developed at the individual level by working with internal thoughts, such as breaking pessimistic thought patterns or cultivating the experience of gratitude by keeping a gratitude journal. Another way to work towards adopting an optimistic mindset is by challenging and re-writing negative self-talk. For example, this can mean changing phrases such as “I will never be able to do this.” to “This is a challenge I look forward to working towards overcoming.” Furthermore, one study notably found that optimism can be increased through a very simple intervention in which individuals imagined their best possible self for five minutes each day.
“Our internal dialogue is everything. What we tell ourselves, the language we use on the inside will come out on the outside,” says Northern. “So, we need to be intentional about being optimistic, generous, and forgiving—this will make such a difference not only for those around us, but for our own health and healing.”
This blog is part of our Gratitude & Reflection newsletter. If you like this content, sign up to receive our monthly newsletter!
Spiritual practices do not have to take place in a church; therefore, every person lives with spirituality in some way. Individuals connect to their spirits and create meaning through various activities, including religious rituals, but also through music, art, or exercise.
“Spirituality, broadly, is the way that we find purpose, connection, belonging, and dignity as human beings,” says Bruce Feldstein, MD, BCC, Stanford Lifestyle Medicine Head of Gratitude and Reflection. “People find it in various ways–it’s not important where you find it; what’s important is just to get started looking for it.”
Dr. Feldstein is a board-certified chaplain at Stanford, where he directs Jewish Chaplaincy Services serving Stanford Medicine and an Adjunct Clinical Professor in the School of Medicine. He sees spirituality as the critical element missing from most lessons on healthy aging from elementary to medical school. His experiences as an Emergency Medicine Physician turned Clinical Chaplain inspired him to create the Spiritual Fitness ToolKit, which helps individuals cultivate well-being by exploring rituals for meaning, purpose, and connection.
“A spiritual practice is as essential to cultivating well-being as physical fitness or nutrition. However, our ‘spiritual fitness’ is typically not discussed as concretely as these other aspects of health,” says Dr. Feldstein.
Four Questions a Day Exercise
The Spiritual Fitness ToolKit opens with a reflection exercise titled “Four Questions a Day.” To develop habits of gratitude and reflection, Dr. Feldstein recommends spending ten minutes of quiet time at the end of the day to contemplate these four questions, one at a time.
The Four Questions:
1. What surprised me today?
2. What touched me today?
3. What inspired me today?
4. For what am I grateful?
Start by asking yourself the first question, What surprised me today? Reflect backward on your day until you come to the first thing that surprised you. Make a note of it in a little journal or on a file on your smartphone. It’s important to write it down. Then do the same with the other questions, one at a time. (This exercise is drawn from research on gratitude and from the teachings of Rachel Naomi Remen MD, originator of the Healer’s Art course.)
After a few weeks of practice, you may begin thinking about these questions throughout your day. Eventually, you may find yourself noticing moments of surprise, being touched, inspiration, and gratitude as they occur. This heightened awareness can allow you to see and respond to situations in your life with “new eyes,” and bring elements of emotional well-being into your everyday experience.
“The Four Questions exercise could be essential in two ways for people getting started,” says Dr. Feldstein. “It can help develop a capacity for increased emotional awareness and encourage people to become reflective practitioners in action.”
Dr. Feldstein suggests committing to this practice for at least three weeks to develop a new habit, and for 90 days to create a new lifestyle. He also suggests engaging in the daily writing activity with a friend to promote connection and enjoyment.
Sharing Moments of Gratitude
An extension of the Four Questions practice is Sharing Moments of Gratitude, another valuable practice in the Spiritual Fitness Toolkit .
Feeling gratitude within oneself is one part of the experience. When we feel grateful for something wonderful in our lives, we can share our appreciation of others by saying or doing something for someone else. Doing so expands the experience of gratitude to those around us.
Sharing gratitude can be done in many ways. Most simply, we can say, “I really appreciate what you just did. Thank you so much.” This is most powerful and the positive experience is mutual and immediate. We may also send a thank you note, or offer a small gift.
One of Dr. Feldstein’s favorite practices is to produce small moments for gratitude at the end of each conversation, discussion, or meeting.
“I often ask my patients or people I am with ‘What can I wish for you today?’ I listen with openness, take in what they say, then respond genuinely with an open heart. This is a practice for offering a blessing. It is one that produces mutual gratitude,” says Dr. Feldstein. “It is a simple practice you can incorporate into any conversation or interaction and greatly encourages connection, healing, and finding peace.”
So, dear reader, what can the Stanford Lifestyle Medicine team wish for you today?
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A few months ago, Stanford Chaplain Bruce Feldstein, MD, BCC, received a call to offer compassion and spiritual care for a woman in her 90s at Stanford Hospital. When Dr. Feldstein entered the hospital room, he saw her husband sitting at her bedside, holding her hand, and looking at his wife of 62 years with eyes of devotion and appreciation. Taking a seat, Dr. Feldstein was deeply touched and inspired by the love they shared between them and the immense gratitude the husband had for his wife. With reverence for the sacred moment, Dr. Feldstein whispered to the man, “Your gratitude and love is a kind of medicine that doesn’t come in an IV.”
Intuitively, we know gratitude is good for our health, and in recent years, researchers have proven this scientifically. Several studies have shown that gratitude practices are associated with a reduction in depression, anxiety, and an improvement in overall mental health. Studies also show that gratitude practices improve physical health, such as lowering blood pressure, improving sleep quality, and creating positive changes in brain activity.
This evidence that gratitude promotes mental and physical health begs the question, “How do we experience more gratitude in our lives?” Perhaps the first step is to have a deeper understanding of what gratitude is.
Gratitude is a Mood
So, what is gratitude, exactly? Although everyone has experienced gratitude to some degree, it isn’t easy to define. Some people have an overall attitude of gratitude, while others only feel thankful when they receive a gift or something good happens in their lives. Many people, however, are somewhere in the middle. They experience gratitude as a mood that comes and goes throughout the day.
It’s useful to be aware of our moods because they serve as metaphorical lenses that determine how we assess situations. For example, if a friend cancels dinner plans, a grateful person might appreciate the extra time in their evening to relax, whereas a person who chronically complains might think they don’t have any true friends. Even though the situation is the same, the responses are different due to the variance of their moods.
Dr. Feldstein notes how we can shift our mood toward gratitude by pausing and reflecting on what we are grateful for. Even with a busy schedule, we can weave in moments of reflection to experience more gratitude and enhance our mood.
“Reflection is an antidote to busyness. When we are busy, we typically don’t notice the wonderful things in our lives. We don’t stop to appreciate what is already there,” says Dr. Feldstein. “Some people say they don’t have time to stop and reflect, but it’s not about time. It’s about having a readiness to notice with appreciation and gratitude what is going on in the midst of our activity. It only takes a brief moment to stop and notice, reflect, and appreciate the things we care about. Doing so contributes to a meaningful life and this can be cultivated.”
Gratitude is a Choice
Due to our biological need to survive, our default thoughts and emotions are often riddled with fear, defensiveness, and complaints. Without consciousness, our instincts prompt us to be on guard and defend ourselves from potential predators, which can be both physical and emotional. When we begin to spiral in these negative emotions, Dr. Feldstein recommends that we make a conscious choice to shift our focus from stressful circumstances to something good.
“Gratitude is a choice,” says Dr. Feldstein. “We don’t have control over what happens, but we do have choices related to how we see things, what we focus on, and ultimately how we respond.”
At any given moment, we can break the spiral of negative thinking by pausing and asking ourselves, “What am I grateful for right now?” By including moments for reflection multiple times a day, we can gradually shift our default thinking from negativity to gratefulness and other elements of well-being due to the neuroplasticity of the brain.
As a chaplain, Dr. Feldstein offers this understanding while accompanying patients in the hospital. “When a patient is going through a difficult time, I compassionately acknowledge their situation and then gently ask, ‘What sustains you?’ and ‘What is something you’re grateful for?'” he says. “This shifts their focus in the direction of well-being, and they begin to feel more at ease, which is a healing experience for both the patient and caregiver.”
Gratitude is Good Medicine
With enough practice in cultivating gratitude, we can start to embody the essence of gratitude while interacting with others. When we start saying “thank you” and “you’re welcome” more often, we feel more connected, and our relationships become stronger, sweeter, and more meaningful.
“Gratitude is not just something we have, it can also be something we are,” says Dr. Feldstein. “Rather than simply knowing the feeling of gratitude, I can be the expression of gratitude that I am inside and share it with others as a way of being. In doing so, we can be a healing force for ourselves, those around us, and the world.”
Dr. Feldstein shares that when healthcare workers pause during the day to prepare their attention and intention to allow for the emergence of presence, appreciation, and gratitude, they have more meaningful and healing connections with their patients.
“When we give and receive gratitude, we all feel better, we see more connection with other people, we see more possibilities in life. Whatever is happening with our physical bodies, gratitude allows us to be in a state of well-being,” says Dr. Feldstein. “So, when we [healthcare workers] are being grateful, it’s an expression of caring, which is enlivening for both the patient and ourselves, and that’s the promise of what medicine is all about.”
For more thoughts on gratitude, read What We Get Wrong About Gratitude written by Stanford Lifestyle Medicine team member, Barbara Waxman.
Bruce Feldstein, MD, BCC, is a distinguished chaplain, physician, and educator at Stanford, renowned for his unique influence in healthcare that bridges the realms of spirituality and medicine. His work is motivated by a desire to inspire a more holistic and compassionate approach to healing. Presently, he serves as a guiding light for the Stanford Lifestyle Medicine Gratitude and Reflection pillar, seamlessly integrating the essence of human existence into the broader field of lifestyle medicine.
“Within healthcare, I see lifestyle medicine as a pathway to recognize the human dimension of living that reflects the essential nature of being human itself,” says Dr. Feldstein. “Through this perspective, we appreciate the human experience with a more comprehensive embrace.”
One of the remarkable aspects of Dr. Feldstein’s work is the emphasis on an individual’s humanity. As an Adjunct Clinical Professor of Medicine at Stanford, he surpasses the boundaries of traditional medical education by bringing forward an understanding of human beings as biological, linguistic, and historical beings who are fragile, interdependent, and mortal. His educational focus includes caring for structural human concerns such as meaning, purpose, connectedness, belonging, and dignity.
At Stanford, he has taught courses that encompass these principles, such as “Spirituality and Meaning in Medicine” and “Physician Self Care and Well-being.” He also teaches “The Healer’s Art,” created by Rachel Naomi Remen, MD, and “Reflection Rounds,” in which medical students, physicians, and chaplains gather to reflect on their inner life experiences. “Reflection Rounds” is now a subject of doctoral dissertations supervised by Dr. Feldstein. He also mentors students, residents, physicians, and chaplains across the country, as well as teaches and gives talks on spirituality and medicine globally.
Humble Beginnings
Born in Detroit, Michigan, Dr. Feldstein’s journey has taken him through diverse experiences in music, medicine, and spirituality. He reminisces, “I’ve been in medicine since I was 2 years old, when my father’s drug store burned down and he went to medical school. As a child, I would join him on countless house calls and hospital rounds.”
Dr. Feldstein attended the University of Michigan, taking advanced pre-medical courses while earning a Bachelor of Science in music focused on theory, analysis, and history.
“Experiencing music can bypass our intellect and touch the core of our meaning and being. There is a healing power in music,” he says. This deep connection to music resonates in his life today as a chaplain, incorporating singing into his spiritual care for its healing energy, meaning, and ritual.
He completed his undergraduate education in just two years, earning membership in Phi Beta Kappa and receiving numerous awards. Remarkably, he was accepted into medical school at the University of Michigan at the age of 20.
His childhood experience of religion, like many assimilating immigrant Jewish families, was oriented around private family gatherings rather than lived publicly or professionally. Yet, Dr. Feldstein was drawn to spiritual and religious experiences throughout his medical education and clinical practice. As a medical student, he witnessed a Christian physician in a small Michigan town emergency room who offered a prayer from his pocket-sized Bible while caring for his long-time patient. Initially, Dr. Feldstein was taken aback, but soon understood the immense comfort this act provided to the patient. Through many moments such as this, he began to recognize the spiritual dimensions of medicine.
Emergency and Disaster Medicine Physician
After graduation from medical school, Dr. Feldstein volunteered as a physician in the pediatric ward of a Cambodian refugee camp on the Thai border. It was the winter of 1979 – 1980, in the aftermath of the genocide and famine that killed one-quarter of the Cambodian population by the country’s Prime Minister, Pol Pot. There, he saw indescribable suffering and horror, as well as the unforgettable human will to live. He also witnessed equanimity and power among the people due to their Buddhist practices. Unavoidably, he began to recognize the crucial importance of the spiritual-humanistic dimensions of human life and how they were missing in Western medicine.
Upon returning to the US, Dr. Feldstein practiced emergency and disaster medicine for 19 years. During this time, he spent a two-year sabbatical with Fernando Flores, PhD, who introduced him to the essential nature of language in medicine, helped him appreciate what it is to be human (ontology), and the power of incorporating these understandings into healthcare, clinical medicine, and everyday life. Flores remains one of Dr. Feldstein’s lifelong teachers.
Shifting from Physician to Chaplain
In 1998, he faced a life-altering injury that rendered it impossible to carry on as an emergency physician. Exploring different career avenues, he became a visiting scholar at the Stanford Center for Biomedical Ethics, mentored by Ernlé Young, PhD. He also ventured to Jerusalem to study Jewish religion and ethics, then returned to Stanford where he discovered a deeper sense of his life’s work as a chaplain.
He completed the residency program in Clinical Pastoral Education to become a spiritual care professional in 2000. He was still serving those in pain and suffering, but now offering comfort and healing from an emotional and spiritual perspective. As a chaplain who was previously an emergency physician, “I had the distinct impression I was bridging two worlds.”
In 2000, he also established the Jewish Chaplaincy Services (JCS), a program dedicated to providing spiritual care and guidance to hospital patients, their families, and caregivers at Stanford Medicine. This involved training spiritual-care volunteers and, as a physician who is a chaplain, contributing to the integration of spirituality into the practice and profession of medicine through education.
Since 2001, as an Adjunct Clinical Professor at the School of Medicine, Dr. Feldstein has developed and taught an award-winning curriculum on spirituality and well-being for medical students and faculty. He received the John Templeton Spirituality and Medicine Curricular Award and was the first recipient of the Isaac Stein Award for Compassionate Care presented by the Stanford Health Care Board of Directors. He is recognized as a Board Certified Chaplain by Neshama: Association of Jewish Chaplains, the professional association for Jewish chaplains worldwide, where he was a past president.
In his multifaceted roles as a leader in lifestyle medicine, chaplain, professor, and director of JCS, Dr. Feldstein remains dedicated to nourishing the souls and minds of the Stanford community.
“Stanford’s commitment to including the spiritual dimension of medicine resonates with my core belief that understanding the essence of being human enhances the ability to address pain and suffering and promote healing in a more profound way,” he says.